Antipsychotic Drugs

Front 1

Why are anti psychotic drugs called major tranquilizers

Back 1

They calm the nerves

Front 2

What is the major cause of psychosis

Back 2

Over firing of the dopaminergic neurones

Front 3

MOA of antipsychotics

Back 3

They block the dopaminergic receptors especially D2 receptors

Front 4

Types of symptoms of psychosis

Back 4

1) positive symptoms

2) negative symptoms

Front 5

Positive symptoms of psychosis

Back 5

1) delusion

2) wild thoughts/ wild imagination

3) hallucinations

4) aggressive behaviour

5) irrational conclusion

Front 6

Negative symptoms of psychosis

Back 6

1) apathy

2) withdrawal from social life

3) avolition( lack of motivation)

4) cognitive deficits

Front 7

Theories that explain psychosis

Back 7

1) dopamine theory

2) glutamate theory

Front 8

Dopamine theory

Back 8

Psychosis is as a result of excess of dopaminergic activity

Front 9

Facts that support the dopamine theory

Back 9

1) postmortem studies on the brain of schizophrenic patients who were not treated with anti-psychotic drugs showed increase in dopaminergic receptors

2) drugs that increase dopaminergic activity like laevodopa worsen schizophrenia

3) there is a decrease in the dopamine metabolite called homovanilic acid when the patient takes antipsychotic drugs

Front 10

Glutamate theory

Back 10

Glutamate is the major "excitatory" neurotransmitter in the brain, which means that it helps to activate neurons and other brain cells.The multiple areas of the brain involved in schizophrenia are connected by a circuit of brain cells that rely on glutamate to communicate. Research so far suggests that either excess or insufficient glutamate activity may cause symptoms, partly through its interactions with other neurotransmitters like dopamine and gamma-aminobutyric acid (GABA).

Glutamatergic models are based upon the observation that the psychotomimetic agents such as phencyclidine (PCP) and ketamine induce psychotic symptoms and neurocognitive disturbances similar to those of schizophrenia by blocking neurotransmission at N-methyl-D-aspartate (NMDA)-type glutamate receptors. Because glutamate/NMDA receptors are located throughout the brain, glutamatergic models predict widespread cortical dysfunction with particular involvement of NMDA receptors throughout the brain. Further, NMDA receptors are located on brain circuits that regulate dopamine release, suggesting that dopaminergic deficits in schizophrenia may also be secondary to underlying glutamatergic dysfunction.

Front 11

Classification of antipsychotics

Back 11

1) first generation/ typical antipsychotics

2) second generation/ atypical antipsychotics

Front 12

What criteria is used to classify antipsychotics

Back 12

Their selectivity to dopamine receptors

Front 13

Disadvantages of the Typicals

Back 13

1) they have severe side effects

2) they are used in combination with the second generation because when used alone, they have resistance issues

Front 14

Why are the typicals considered as the best bet for treatment

Back 14

They are more potent than the atypicals

Front 15

Classification of the Typical antipsychotics

Back 15

1) phenothiazones

2) thioxanthines

3) butyrophenones

Phyno is TIRED of his BOOTS and PHYNO is TIRED of his XANS

Front 16

Classification of the phenothiazones

Back 16

Aliphatics and piperidines

Front 17

Examples of aliphatic phenothiazones

Back 17

1) chloropromazine

2) triflupromazine

think of CHLOROQUINE and The FLU and PROMAC PHARMACY

Front 18

Examples of piperidines phenothiazones

Back 18

Mesoridazine

Front 19

Classification of the thioxanthines

Back 19

Aliphatics and piperidines

Front 20

Example of aliphatic thioxanthines

Back 20

Chlorprothixene

Front 21

Example of piperidine thioxanthine

Back 21

Flupenthixol

Front 22

Examples of butyrophenones

Back 22

Haloperidol and Droperidol

Front 23

What class of drugs do the Atypicals belong to

Back 23

Dibenzodiazepines

Front 24

Classification of the dopamine receptors

Back 24

D1-like : D1 and D5 receptors

D2-like : D2, D3 and D4 receptors

Front 25

Dopaminergic pathways in the brain

Back 25

1) nigrostatial pathway

2) mesolimbic-mesocortical pathway

3) tuberoinfundibular pathway

Front 26

Significance of the nigrostatial pathway

Back 26

It deals with voluntary movement and posture. Blockade of this pathway leads to extrapyramidal side effects

Front 27

Significance of mesolimbic-mesocortical pathway

Back 27

Higher mental and emotional function. Overfiring results in psychosis. The major role of anti-psychotic drugs lies in this pathway

Front 28

Significance of the tuberoinfundibular pathway

Back 28

Activation of this pathway inhibits prolactin secretion i.e milk secretion

Front 29

Diseases where antipsychotics are used

Back 29

1) schizophrenia

2) tourrette syndrome

3) nausea and vomitting

4) mania disorders

5) Alzheimer's

6) Huntington's disease

Front 30

Pharmacological actions of anti-psychotic drugs

Back 30

1)CNS depressants

2) decrease seizure threshold ( it worsens seizure); it is not taken alongside anti-seizure drugs

3) weight gain ( especially the Atypicals)

4) orthostatic hypotension

5) decreased libido in women; amenorrhea and infertility

6) decreased libido in men; gynaecomastia

7) serious neurological effects/extrapyramidal side effects (EPS)-akatisia, dyskenisia, Parkinsonism, dystonia and tremor and neuroleptic malignant syndrome

8) as antiemetics e.g promethazine

Front 31

What is akathisia

Back 31

A sensation of restlessness characterized by an inability to sit still/down or remain motionless/seated, arising from a subjective need or desire to move, often coinciding with the sensation of twitching of muscles, often as a side effect of psychiatric medications.

Front 32

Drugs that can be used to treat akathisia

Back 32

1) benzodiazepines

2) non-selective beta blockers

Front 33

What is dystonia

Back 33

Uncontrolled movements of the head, neck, face and tongue

Front 34

Drugs used to control distonia

Back 34

Centrally acting anti-muscarinic agents e.g benztropine

Front 35

What is parkinsonism

Back 35

A neurological syndrome characterized by tremor, bradykinesia, rigidity, and postural instability;

Front 36

Symptoms of neuroleptic malignant syndrome

Back 36

Fever

Increased blood pressure

Extreme rigidity

Increased heart rate

Front 37

Drug used in neuroleptic malignant syndrome

Back 37

Bromocriptine and dantrolene

Front 38

What is dyskinesia

Back 38

impairment of voluntary movements resulting in fragmented or jerky motions

Front 39

How to manage dyskinesia

Back 39

Discontinue the antipsychotic. Replace

Front 40

Other side effects of antipsychotics

Back 40

1) gynaecomastia

2) amenorrhea

3) breast engorgement

4) infertility

5) weight gain

6) cholesteric jaundice caused by chlorpromazine

7) glycopenia

8) blurred vision

9) retinopathy

Front 41

Contraindications of antipsychotics

Back 41

1) hypotension

2) CNS depression

3) Parkinsons

4) bone marrow depression

5) hepatic failure because they are metabolized by cytochrome P450

6) seizure

Front 42

Drug interactions of anti-psychotics

Back 42

1) inhibit action of dopamine and laevodopa

2) concomitant administration with diuretics and antihypertensives lead to marked hypotensive effect

Give a 2-3hr interval between drugs